Provider Demographics
NPI:1518389832
Name:MARLBORO ULTRASOUND IMAGING CENTER
Entity Type:Organization
Organization Name:MARLBORO ULTRASOUND IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-462-0111
Mailing Address - Street 1:211 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2290
Mailing Address - Country:US
Mailing Address - Phone:732-462-0111
Mailing Address - Fax:732-462-7711
Practice Address - Street 1:211 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2290
Practice Address - Country:US
Practice Address - Phone:732-462-0111
Practice Address - Fax:732-462-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07551800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006866Medicaid